Why do payers and health plans need a provider portal?

October 30, 2021

The process of onboarding and supporting providers in your network is becoming more complicated than ever before. With the recent CMS mandates around provider directory data, the old processes for onboarding, credentialing and contracting with your providers will not be enough to meet new data accuracy challenges. More importantly, providing a seamless and easy experience for your providers to join and stay in-network will be necessary to continue to establish contracts for the most cost effective services for your members. Scott Vasey, sums it up well in our podcast “Enhancing the Provider Experience”.  “We had a lot of boxed solutions, but none that actually created an entire workflow that allowed us to bring in data about a provider, enroll them in the plan, credential them, contact them, produce directories, pay claims, and ultimately service that provider in a way that brought the data back to them and was consistent and usable throughout the organization,” Vasey explained.

Managing providers in multiple networks with multiple payment terms is complicated for your organization. Imagine the providers with contracts with hundreds of health plans in their region. Why not make their jobs easier to contract with your organization. This could make the difference in your ability to have a competitive advantage in a specific market.

Giving providers a place to see it all

That is where Digital-360 comes into play. In your organization, having the ability to see a 360-degree view of the provider and all their networks, demographic information and practicing relationships is key to serving their needs and ultimately serving the needs of your members. Having a place for providers to communicate and interact with you will not only help them — it will eliminate much manual effort on your organizations part. Many data entry and communication issues with your providers around the following can be streamlined or resolved, such as:

  • Provider applications
  • Credentialing
  • Pre-authorization requests and approvals
  • Claims inquiries
  • Contracting questions and fee schedule inquiries
  • Appeals and grievances
  • Provider directory data updates

Payers offering a robust and efficient provider portal will not only have a competitive advantage to build better networks faster and more effectively, but will also create a loyalty with their provider network that will ultimately better serve their member populations.

A robust and integrated Provider Lifecycle Management solution

To provide a streamline experience for your providers, you must have a robust, streamlined and accurate provider lifecycle management platform to manage the end to end process for provider onboarding and the ongoing provider data updates necessary to effectively manage the provider networks. That is where V12 Network and V12 IPD (Intelligent Provider Directory) build on Salesforce Health Cloud come in. Our system provides a complete end to end enterprise solution for the provider journey with build in integrations to CAQH and OIG compliance with ProviderTrust. Eliminating silo’s and creating a great experience for both your employees and the providers they interact with everyday has never been easier!

A robust Provider Lifecycle solution provides the backbone and processes to support a digital 360 provider portal for your providers. Internally your team should have a complete end-to=end solutions that provides the following functionality:

Technology is constantly changing the way we interact with each other. Healthcare consumers expect the same level of support and communication with their healthcare as they get with Facebook, Amazon, or Apple.

Do you have the technology you need to manage your providers and provider networks? Get in touch with us to discuss how Salesforce and our V12 Network and V12 IPD “Intelligent Provider Directory” works with Salesforce Digital 360 to provide a unparalleled level of provider experience and efficiencies.